Young US Research Articles

Are Young US Adults Meeting the National Academy of Medicine Recommendations for Adequate Water Intakes? Analyses of NHANES 2011–16 Data

Abstract Objectives Young US adults consume inadequate amounts of recommended food groups, including fruit, vegetables, and whole grains but little is known about their fluid consumption. The present study aimed to evaluate if this population is meeting the recommendations for adequate fluid intake issued by National Academy of Medicine (NAM). Methods Beverage consumption data for 2160 adults aged 18–24y came from two 24 h dietary recalls in the three most recent cycles of the United States National Health and Nutrition Examination Survey (NHANES 2011–16). Water intakes (in mL/d) from drinking water, other beverages and moisture from foods were analyzed in relation to the current NAM Adequate Intake (AI) thresholds (3700 mL/d for males and 2700 mL/d for females). The proportion of young adults adhering to the AIs for total water intake was assessed using the National Cancer Institute method for estimating usual intake distributions. Additional analyses examined adherence by gender, income-to-poverty ratio and race/ethnicity. Results Mean water intakes were 2713 mL/d (3003 mL/d for men and 2382 mL/d for women). Of total water, 1191 mL/d (44%) came from drinking water, tap and bottled; 947 mL/d (35%) from non-water beverages; and 575 mL/d (21%) from foods. Only 35.3% of young adults met the AI recommendations. Female young adults were significantly more likely to meet the recommendations than males (37.8% vs. 29.6%; P = 0.04). Compared to the other race/ethnicity groups, non-Hispanic white young adults were most likely to meet recommendations (41.5%). Compared to non-Hispanic white young adults, non-Hispanic black young adults were least likely (18.7%, P < 0.001) to meet recommendations. Mexican-American (29.3%) and other Hispanic young adults (32.3%, P < 0.05 for each) were also less likely to meet recommendations when compared to non-Hispanic white young adults. No significant effects by family income were observed. Conclusions Less than half of all young adults and only 18.7% of non-Hispanic Black young adults met the AI recommendations for water. Understanding the reasons for the high proportion of young adults failing to meet recommendations should be the subject of future research. Given the impact of habitual fluid intake on health outcomes, adequate hydration among young adults remains a cause for concern. Funding Sources Data analyses were sponsored by PepsiCo Inc.

Patterns of Influenza Vaccination and Vaccine Effectiveness Among Young US Children Who Receive Outpatient Care for Acute Respiratory Tract Illness

The burden of influenza among young children is high, and influenza vaccination is the primary strategy to prevent the virus and its complications. Less is known about differences in clinical protection following 1 vs 2 doses of initial influenza vaccination. To describe patterns of influenza vaccination among young children who receive outpatient care for acute respiratory tract illness in the US and compare vaccine effectiveness (VE) against medically attended laboratory-confirmed influenza by number of influenza vaccine doses received. This test-negative case-control study was conducted in outpatient clinics, including emergency departments, at 5 sites of the US Influenza Vaccine Effectiveness Network during the 2014-2015 through 2017-2018 influenza seasons. The present study was performed from November 5, 2014, to April 12, 2018, during periods of local influenza circulation. Children aged 6 months to 8 years with an acute respiratory tract illness with cough who presented for outpatient care within 7 days of illness onset were included. All children were tested using real-time, reverse-transcriptase polymerase chain reaction for influenza for research purposes. Vaccination in the enrollment season with either 1 or 2 doses of inactivated influenza vaccine as documented from electronic medical records, including state immunization information systems. Medically attended acute respiratory tract infection with real-time, reverse-transcriptase polymerase chain reaction testing for influenza. Of 7533 children, 3480 children (46%) were girls, 4687 children (62%) were non-Hispanic white, and 4871 children (65%) were younger than 5 years. A total of 3912 children (52%) were unvaccinated in the enrollment season, 2924 children (39%) were fully vaccinated, and 697 children (9%) were partially vaccinated. Adjusted VE against any influenza was 51% (95% CI, 44%-57%) among fully vaccinated children and 41% (95% CI, 25%-54%) among partially vaccinated children. Among 1519 vaccine-naive children aged 6 months to 2 years, the VE of 2 doses in the enrollment season was 53% (95% CI, 28%-70%), and the VE of 1 dose was 23% (95% CI, -11% to 47%); those who received 2 doses were less likely to test positive for influenza compared with children who received only 1 dose (adjusted odds ratio, 0.57; 95% CI, 0.35-0.93). Consistent with US influenza vaccine policy, receipt of the recommended number of doses resulted in higher VE than partial vaccination in 4 influenza seasons. Efforts to improve 2-dose coverage for previously unvaccinated children may reduce the burden of influenza in this population.

Predictors of coronary artery calcium among 20-30-year-olds: The Coronary Artery Calcium Consortium

Background and aimsWe sought to understand the risk factor correlates of very early coronary artery calcium (CAC), and the potential investigational value of CAC phenotyping in adults aged 20–30 years. MethodsWe studied all participants aged 20–30 years at baseline (N = 373) in the Coronary Artery Calcium Consortium, a large multi-center cohort study of patients aged 18 years or older without known atherosclerotic cardiovascular disease (ASCVD) at baseline, referred for CAC scoring for clinical risk stratification. We described the prevalence of CAC in men and women, the frequency of risk factors by the presence of CAC (CAC = 0 vs CAC >0), and assessed the association between traditional non-demographic CVD risk factors (hypertension, hyperlipidemia, smoking, family history of CHD, and diabetes) and prevalent CAC, using age- and sex-adjusted logistic regression models. ResultsThe mean age of the study participants was 27.5 ± 2.4 years; 324 (86.9%) had CAC = 0, and 49 (13.1%) had CAC >0. Among the 49 participants with CAC, 38 (77.6%) were men, and median CAC score was low at 4.6. In age- and sex-adjusted models, there was a graded increase in the odds of CAC >0 with increasing traditional cardiovascular disease (CVD) risk factor burden (p = 0.001 for linear trend). Participants with ≥3 traditional risk factors had a statistically significant higher odds of having prevalent CAC (OR 5.57, 95% CI; 1.82–17.03) compared to participants with no risk factors. ConclusionsOur study demonstrates the non-negligible prevalence of CAC among very high-risk young US adults, reinforcing the critical importance of traditional risk factors in the earliest development of detectable subclinical ASCVD.

Closing the enjoyment gap: heritage language maintenance motivation and reading attitudes among Chinese-American children

ABSTRACT Research demonstrates strong associations between psychosocial factors (motivation, attitudes, beliefs), outside of class behavior, and second language (L2) learning, particularly reading achievement [Briggs and Walter 2016. Read On! Extensive Reading and Young Second Language Learners’ Motivation and Attitudes; Masgoret and Gardner 2003. “Attitudes, Motivation, and Second Language Learning: A Meta-Analysis of Studies Conducted by Gardner and Associates.” Language Learning 53 (S1): 167–210]. Fewer studies have explored the attitudes of students studying a heritage language (HL). Mandarin Chinese is the second most commonly spoken home language among dual language learner children in the U.S. [Park, Zong, and Batalova 2018. Growing Superdiversity among Young US Dual Language Learners and its Implications. Washington, DC: Migration Policy Institute] and increasing numbers of children receive explicit Chinese instruction. Comparatively less is known, however, regarding their attitudes toward Chinese maintenance and reading or the impact on intended effort. The current study addressed language learning attitudes and motivations, language specific reading attitudes, and out-of-school language use in physical and digital environments, among 58 children ages 10–18 enrolled in Chinese school. Findings revealed that ideal self accounted for significant variance in school effort (12%), but less than previously found in other contexts. L1/L2 reading attitudes had a significant negative relationship; the more enjoyable reading in English, the less enjoyable reading in Chinese. Chinese reading activity in digital environments uniquely accounted for significant variance in school effort. Results expand our understanding of motivation variability and underscore the importance of digital environments for young learners.

The Put It Out Project (POP) Facebook Intervention for Young Sexual and Gender Minority Smokers: Outcomes of a Pilot, Randomized, Controlled Trial.

This trial investigated whether a Facebook smoking cessation intervention culturally tailored to young sexual and gender minority (SGM) smokers (versus non-tailored) would increase smoking abstinence. Participants were 165 SGM young adult US smokers (age 18-25) recruited from Facebook in April 2018 and randomized to an SGM-tailored (POP; N = 84) or non-tailored (TSP-SGM; N = 81) intervention. Interventions delivered weekly live counseling sessions and 90 daily Facebook posts to participants in Facebook groups. Primary analyses compared POP and TSP-SGM on biochemically verified smoking abstinence (yes/no; primary outcome), self-reported 7-day point prevalence abstinence (yes/no), reduction in cigarettes per week by 50+% from baseline (yes/no), making a quit attempt during treatment (yes/no), and stage of change (precontemplation/contemplation vs. preparation/action). Supplemental analyses compared POP to two historical control groups. POP participants were more likely than TSP-SGM participants to report smoking abstinence at 3 (23.8% vs. 12.3%; OR = 2.50; p = .03) and 6 months (34.5% vs. 12.3%; OR = 4.06; p < .001) and reduction in smoking at 3 months (52.4% vs. 39.5%; OR = 2.11; p = .03). Biochemically verified smoking abstinence did not significantly differ between POP and TSP-SGM at 3 (OR = 2.00; p = .33) or 6 months (OR = 3.12; p = .08), potentially due to challenges with remote biochemical verification. In supplemental analyses, POP participants were more likely to report abstinence at 3 (OR = 6.82, p = .01) and 6 (OR = 2.75, p = .03) months and reduced smoking at 3 months (OR = 2.72, p = .01) than participants who received a referral to Smokefree.gov. This pilot study provides preliminary support for the effectiveness of a Facebook smoking cessation intervention tailored to SGM young adults. SGM individuals have disproportionately high smoking prevalence. It is unclear whether smoking cessation interventions culturally tailored to the SGM community are more effective than non-tailored interventions. This pilot trial found preliminary evidence that an SGM-tailored Facebook smoking cessation intervention increased reported abstinence from smoking, compared to a non-tailored intervention. NCT03259360.

Differences in Breast Cancer Stage at Diagnosis by Ethnicity, Insurance Status, and Family Income in Young Women in the USA.

Describe the clinical and epidemiological data from young women with breast cancer and determine the association between ethnicity, insurance status, family income, and breast cancer stage at the diagnosis in this population. Women under the age of 40 diagnosed with invasive breast cancer from 2010 to 2014 and identified in the Surveillance, Epidemiology, and End Results (SEER) 18 registries database were included. Binary logistic regression was applied in order to estimate the odds ratios (ORs) for factors that were potentially predictive for receiving a breast cancer diagnosis at stage I. Of 14,379 young women with invasive breast cancer, 70.9% of the patients were white, 15.9% black, and 13.2% classified as other ethnicity (American Indian, Asian, Pacific Islander). The initial clinical stage at diagnosis was stage I in 28.2%, II in 45.2%, III in 19.0%, and IV in 7.6%. The chi-square test showed a significant association between clinical stage at diagnosis and family income (p < 0.0001), insurance status (p < 0.0001), and ethnicity (p < 0.0001). The ORs for being diagnosed at stage I, regarding different factors, revealed that women with family income higher than US$ 85,000 were more likely to be diagnosed with stage I (OR [95%CI], 1.306 [1.173-1.454]; p value < 0.0001) when compared with patients with family income of less than US$ 60,000. Black women were less likely to be diagnosed with stage I (OR [95%CI], 0.676 [0.605-0.755]; p value < 0.0001), when compared with white women. Uninsured women were less likely to be diagnosed with stage I (OR [95%CI], 0.586 [0.529-0.648]; p value < 0.0001) when compared with women with insurance coverage. Among young US women diagnosed with invasive breast cancer, most of them presented early stage disease. Women with black ethnicity, low income, and uninsured are at risk for late-stage presentation. Improvements in strategies to allow earlier breast cancer diagnosis in these at risk population are urged.

Evolution of the Oropharynx Cancer Epidemic in the United States: Moderation of Increasing Incidence in Younger Individuals and Shift in the Burden to Older Individuals.

Human papillomavirus-positive oropharynx cancer incidence has increased rapidly in cohorts of US white men born during the 1930s to 1950s. It is unknown how the trajectory of the oropharynx cancer epidemic may be changing in the United States. Using US cancer registry information, we investigated whether increases in oropharynx cancer have continued into recent birth cohorts and forecasted the future burden across age, sex, and race/ethnicity subgroups. Log-linear Joinpoint regression and age-period-cohort models were used to evaluate incidence trends during 1992 to 2015 and projections through 2029. Among white men, oropharynx cancer incidence increased rapidly in individuals born during 1939 to 1955 (5.3% per 2-year birth cohort; 95% CI, 4.8% to 5.7%), but this rate of increase significantly moderated in individuals born during 1955 to 1969 (1.7% per 2-year birth cohort; 95% CI, 1.0% to 2.4%). Should these birth-cohort trends continue, from 2016 to 2029 we forecast that incidence will increase dramatically in older white men 65 to 74 years of age (from 40.7 to 71.2 per 100,000) and 75 to 84 years of age (from 25.7 to 50.1 per 100,000), moderately in white men 55 to 64 years of age (from 40.3 to 52.0 per 100,000), and remain stable in white men 45 to 54 years of age (approximately 18 per 100,000). Accounting for population growth, we project an increase in annual number of cases in the United States from 20,124 (95% CI, 19,779 to 20,469) in 2016 to 30,629 (95% CI, 29,413 to 31,845) in 2029, primarily driven by older individuals (age ≥ 65 years; from 7,976 [95% CI, 7,782 to 8,172] to 18,072 [95% CI, 17,271 to 18,895]) and white men (from 14,453 [95% CI, 14,142 to 14,764] to 22,241 [95% CI, 21,119 to 23,364]). The exponential increase in oropharynx cancer incidence in young white US men has ebbed, and modest increases are occurring/anticipated in cohorts born after 1955. Continued strong increases in incidence in cohorts born before 1955, and an approximate 50% increase in size of the US population age 65 years or older through 2029, portend a substantial shift in burden to elderly white men.

Trends and Characteristics Associated With Human Papillomavirus Vaccination Uptake Among Men Who Have Sex With Men in the United States, 2014-2017.

Human papillomavirus (HPV) and HPV-associated cancer rates are high among men who have sex with men (MSM). The US Advisory Committee on Immunization Practices recommends HPV vaccination for all MSM through age 26 years. We examined trends in HPV vaccine uptake among young US MSM between 2014 and 2017. Cochran-Armitage tests and estimated annual percentage changes were used to examine annual trends (2014-2017) in HPV vaccination initiation among US MSM ≤26 years as of 2011 who participated in a nationwide annual cross-sectional online survey. We identified independent correlates of HPV vaccination in 2017 using Poisson regression modeling. There were 2,381 participants in 2014; 4,143 in 2015; 3,926 in 2016; and 3,407 in 2017. Mean age was 23.5 years, 39% lived in metropolitan areas, and 37% lived in the South. HPV vaccination significantly increased (P < 0.0001) from 22.5% in 2014 to 37.6% in 2017 (estimated annual percentage change = 17.4%). HPV vaccination was significantly greater for MSM who were younger, had health insurance, saw a healthcare provider in the past 12-months, resided in the Northeast, resided in metropolitan areas, had higher household income, disclosed their sexual identity to health care provider, and had gonorrhea/chlamydia diagnosis in the past 12-months. Human papillomavirus vaccination among MSM increased from 2014 to 2017, but vaccine uptake varied significantly by MSM subgroup. Despite favorable trends, the HPV vaccination coverage for this population (37.6%) is less than half of the Healthy People 2020 target (80%). Additional efforts are needed to increase coverage.

Neurotoxicity of general anesthetics in children: evidence and uncertainties.

Compelling evidence in animal models that, under some conditions, general anesthetics and sedatives produce changes in the brain and persistent impairments in learning, memory, and behavior. The present review summarizes recent clinical studies investigating whether the use of these agents in children causes similar neurotoxicities. Although the results of retrospective studies are somewhat mixed, multiple exposures to general anesthesia were generally found to confer greater risk than single exposures with regard to learning disability, attention deficit hyperactivity disorder, school readiness, and academic achievement. Recent clinical studies, including a large randomized controlled trial, are consistent in confirming that a single exposure in infancy to general anesthesia lasting less than 1 h is not associated with neurodevelopmental impairments in later childhood. These studies do not, however, clarify the potential impacts of longer exposures or multiple exposures. Given that approximately half of the anesthetic exposures in young US children are 1 h or less in duration, the results of the recent clinical studies are reassuring. Because of the clinical necessity of administering general anesthetics and sedatives for longer periods for many surgical, procedural, or diagnostic purposes, the identification of adjuvants that prevent or reduce the potential neurotoxicity of these agents is an area of active research.

Abstract P1-08-03: An early look at incidence and survival by HR and HER2 status among young US women with stage I-III breast cancer: SEER 2010-15

Abstract Background: Population-based contemporary incidence and survival patterns for breast cancer by receptor status (hormone receptor [HR]; human epidermal growth factor receptor 2 [HER2]) among young US women have not been described. Methods: We identified pre-, peri-, and early postmenopausal women ages 20-29 (n=1,617), 30-39 (n=12,910), 40-49 (n=47,313), and 50-59 (n=68,870) diagnosed with Stage I-III breast cancer from 2010-15 in the Surveillance, Epidemiology and End Results (SEER) database using SEER*Stat version 8.3.5. Of these, respective totals for women with reported HR and non-borderline HER2 status were 1533 (94.8%), 12,225 (94.6%), 44,684 (94.4%), and 64,844 (94.2%). Using this analytic sample, we estimated annual percentage change (APC) in incidence. Restricting the sample to women diagnosed from 2010-14, we estimated four-year survival (maximum available follow-up). Analyses were stratified by age group and receptor status. Results: The proportion of HER2+/HR+ cancer was highest among women 20-29, decreasing with increasing age; that for HER2+/HR- cancer was lower, differing less across age groups (Table 1). For HER2- cancer, the proportion of HER2-/HR+ cancer was lowest for women 20-29 and increased with age; the opposite pattern was observed for HER2-/HR- cancer. Overall, stage I-III breast cancer increased in incidence from 2010-15 for all age groups, with the APC greatest in women 20-29 [2.20](30-39 [1.98], 40-49 [1.91], 50-59 [1.62]). The patterns for the APCs by age and receptor status tended to reflect those for the observed proportions, except those for women with HER2+/HR- cancer, which tended to increase with increasing age (Table 1). Four-year survival estimates for women 20-29, although imprecise, differed by HER2 status, being higher for those with HER2+ than HER2- cancer, and this difference persisted for HR+ and HR- cancers among these women (Table 2). In the other age groups, survival differed by HR status, being higher for women with HR+ than HR- cancer. Conclusions: Using SEER data representative of over one-quarter of the US population, Stage I-III breast cancer has increased among young women in recent years. In particular, HER2+/HR+ and HER2-/HR- cancers were over-represented and estimated to have the highest APCs among women 20-39 compared to those 40-59. Receptor status was observed to influence survival differently across age groups. The differences in four-year survival observed among women 20-29 with HR+ cancers may have implications as we consider anti-estrogen therapy options for these youngest premenopausal women. Table 1:Breast Cancer Frequency and APCReceptorsAge 20-2930-3940-4950-59 N (%) HER2+/HR+331(21.6)2225(18.2)5865(13.1)7706(11.9)HER2+/HR-109(7.1)863(7.0)2254(5.0)3664(5.7)HER2-/HR+733(47.8)6769(55.2)30809(69.0)45693(70.5)HER2-/HR-360(23.5)2398(19.6)5756(12.9)7781(12.0) APCHER2+/HR+5.44.93.94.4HER2+/HR-1.22.14.43.2HER2-/HR+-1.11.51.91.6HER2-/HR-6.50.5-1.1-1.5 Table 2:Four-Year Breast Cancer SurvivalReceptorsAge 20-2930-3940-4950-59 %(SE) HER2+/HR+95.3(1.7)95.5(0.6)96.0(0.4)94.4(0.4)HER2-/HR+95.0(2.9)91.9(1.3)90.8(0.9)90.8(0.7)HER2-/HR+90.6(1.6)93.1(0.4)96.2(0.2)95.6(0.1)HER2-/HR-82.2(2.8)80.3(1.1)82.8(0.7)82.5(0.6)SE: standard error Citation Format: Thomas A, Rhoads A, Pinkerton E, Melin S, Oleson JJ, McNally LR, Hundley WG, Conway K, Lynch CF, Romitti PA. An early look at incidence and survival by HR and HER2 status among young US women with stage I-III breast cancer: SEER 2010-15 [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-08-03.

Trends in stage at diagnosis for young breast cancer patients in the United States.

Previous studies reported increasing rates of metastatic breast cancer among young US women. However, these studies were based on limited geographic areas and did not account for the sharp decline in unknown-stage disease. In this study, we examined trends in early-onset breast cancer incidence rates by stage at diagnosis in a national dataset, after correcting for temporal changes in unstaged disease. Using data from 42 states, covering 82% of the US population, we examined trends in incidence rates by stage at diagnosis and race/ethnicity in women ages 20-39years. Stage was imputed for non-Hispanic (NH) white and NH black cases with missing information by distributing cases proportionally according to survival statistics. During 2001-2015, incidence rates of early-onset metastatic breast cancer increased sharply among NH white, NH black, Hispanic, and Asian/Pacific Islander (API) women. Increasing trends were also observed for local-stage disease (all racial/ethnic groups) and regional-stage disease (NH white and API). In contrast, rates decreased sharply for unstaged disease among all groups. After imputing stage for cases with missing information, the increasing trends for regional- and distant-stage disease in NH whites and local-stage disease in NH blacks were no longer statistically significant, but the increase in distant-stage disease in NH blacks was unchanged. After accounting for the sharp decline in unstaged cases, the increase in incidence rates for distant-stage disease became non-significant in NH whites but not in NH blacks. Future studies should consider accounting for temporal changes in unstaged disease when examining stage-specific incidence trends.

Short term risk of non-fatal and fatal suicidal behaviours: the predictive validity of the Columbia-Suicide Severity Rating Scale in a Swedish adult psychiatric population with a recent episode of self-harm

BackgroundThe Columbia-Suicide Severity Rating Scale (C-SSRS) is a relatively new instrument for the assessment of suicidal ideation and behaviour that is widely used in clinical and research settings. The predictive properties of the C-SSRS have mainly been evaluated in young US populations. We wanted to examine the instrument’s predictive validity in a Swedish cohort of adults seeking psychiatric emergency services after an episode of self-harm.MethodsProspective cohort study of patients (n = 804) presenting for psychiatric emergency assessment after an episode of self-harm with or without suicidal intent. Suicidal ideation and behaviours at baseline were rated with the C-SSRS and subsequent non-fatal and fatal suicide attempts within 6 months were identified by record review. Logistic regression was used to evaluate separate ideation items and total scores as predictors of non-fatal and fatal suicide attempts. Receiver operating characteristics (ROC) curves were constructed for the suicidal ideation (SI) intensity score and the C-SSRS total score.ResultsIn this cohort, the median age at baseline was 33 years, 67% were women and 68% had made at least one suicide attempt prior to the index attempt. At least one non-fatal or fatal suicide attempt was recorded during follow-up for 165 persons (20.5%). The single C-SSRS items frequency, duration and deterrents were associated with this composite outcome; controllability and reasons were not. In a logistic regression model adjusted for previous history of suicide attempt, SI intensity score was a significant predictor of a non-fatal or fatal suicide attempt (OR 1.08; 95% CI 1.03–1.12). ROC analysis showed that the SI intensity score was somewhat better than chance in correctly classifying the outcome (AUC 0.62, 95% CI 0.57–0.66). The corresponding figures for the C-SSRS total score were 0.65, 95% CI 0.60–0.69.ConclusionsThe C-SSRS items frequency, duration and deterrents were associated with elevated short term risk in this adult psychiatric cohort, as were both the SI intensity score and the C-SSRS total score. However, the ability to correctly predict future suicidal behaviour was limited for both scores.

Insulin resistance since early adulthood and appendicular lean mass in middle-aged adults without diabetes: 20 years of the CARDIA study

AimsTo determine the association between 20-year trajectories in insulin resistance (IR) since young adulthood and appendicular lean mass (ALM) at middle-age in adults without diabetes. MethodsA prospective cohort study was designed among young and middle-aged US men (n = 925) and women (n = 1193). Fasting serum glucose and insulin were measured five times in 1985–2005. IR was determined using the homeostasis model assessment (HOMA). ALM was measured in 2005 and ALM adjusted for BMI (ALM/BMI) was the outcome. Sex-specific analyses were performed. ResultsThree HOMA-IR trajectories were identified. Compared to the low-stable group, the adjusted ALM/BMI difference was −0.041 (95% CI: −0.060 to −0.022) and −0.114 (−0.141 to −0.086) in men, and −0.052 (−0.065 to −0.039) and −0.043 (−0.063 to −0.023) in women, respectively, for the medium-increase and high-increase groups. Further adjusting for the treadmill test duration attenuated these estimates to −0.022 (−0.040 to −0.004) and −0.061 (−0.089 to −0.034) in men and −0.026 (−0.038 to −0.014) and −0.007 (−0.026 to 0.012) in women. ConclusionsCompared to the low-stable insulin resistance trajectory between early and middle adulthood, the high-increase trajectory was associated with lower ALM/BMI in middle-aged men, but not women, without diabetes, after adjusting for cardiorespiratory fitness.

Renal albumin excretion in healthy young adults and its association with mortality risk in the US population.

Current classification systems do not specify a healthy normal range for urinary albumin excretion. Occult microvascular disease induced by a Western lifestyle may mean that normal values for apparently healthy adults exceed optimal levels defined by mortality risk. Using a national population sample [the US Third National Health and Nutrition Examination Survey (NHANES III) cohort; n = 11887], the distributions of albumin:creatinine ratio (ACR) and fractional excretion of albumin (FEalb) were studied in healthy young adults [ages 20-40 years, without cardiovascular disease (CVD) or risk factors]. The threshold for mortality risk prediction in the whole adult population sample was then studied across ACR/FEalb categories corresponding to quartiles for healthy young adults. ACR quartiles for healthy young adults were 2.7, 4.2 and 5.9 mg/g in men and 3.8, 6.2 and 9.8 mg/g in women. Increases in ACR below the medians for healthy young adults were not associated with increased mortality or with cardiovascular risk factors when tested in the whole adult population. Increases above this threshold were independently associated with mortality risk [hazard ratio 1.2 (95% confidence interval 1.1-1.4) and 1.8 (1.6-2.0) for Quartiles 3 and 4, respectively]. The prevalence of an optimal ACR below the mortality risk threshold was <25% in the setting of diabetes, hypertension, age >70 years or CVD. Using FEalb to define quartiles of albuminuria gave the same findings. Based on mortality risk in the whole adult population, there is an optimal range of albumin excretion (ACR < 6 mg/g and 4 mg/g for women and men, respectively). However, only half of even apparently healthy young US adults fall within this range.

Self-reported depressive symptoms in adolescence increase the risk for obesity and high BP in adulthood

BackgroundNegative psychological symptoms may impact cardiovascular (CV) risk factors such as obesity and abnormal blood pressure (BP). Currently, a third of the US population is obese (BMI ≥ 30 kg/m2) and nearly half have high BP (BP > 120/80 mmHg). This research aims to investigate whether self-reported depressive symptoms in adolescence affect adulthood obesity and high BP. MethodsWe leveraged the data from a representative sample of US individuals collected by the National Longitudinal Study of Adolescent to Adult Health (Add Health). We identified the survey questions pertaining to self-reported depressive symptoms in over 14,000 adolescents. Based on their follow-up health test in adulthood, we evaluated the impact of adolescent depressive symptoms on adulthood obesity and high BP by adjusting for socio-demographic, socio-economic and adolescent health status. ResultsThis study reveals a high prevalence of obesity (36%) and high BP (66%) among young US adults with an average age of only 28 years. Excessive moodiness in adolescence significantly impacted the development of obesity in early adulthood (p-value <0.001). ‘Feeling sad’ on most days in adolescence significantly increases the risk of obesity (p-value 0.01) and high BP (p-value <0.03) in early adulthood. ConclusionsThis study demonstrates self-reported moodiness in adolescence to be a significant predictor of obesity in adulthood. Feeling sad on most days increase the subsequent risk for high BP. Early intervention may improve lifestyle and CV outcomes.

Nonalcoholic Steatohepatitis is the Most Rapidly Increasing Indication for Liver Transplantation in Young Adults in the United States.

To analyze the frequency and trend of liver transplantation (LT) for nonalcoholic steatohepatitis (NASH) cirrhosis in young adults aged 18 to 40 years and to assess post-LT outcomes in this age group. NASH is currently the fastest-growing indication for LT in US adults. It is believed that NASH is a rare indication for LT among young adults. Using the United Network for Organ Sharing database, we performed a retrospective cohort analysis of all LTs in young adults between 2002 and 2012. Incidence rate ratio was calculated for each indication. A total of 5157 young adults underwent LT over the study period-54% were male, 23% obese. Mean (±SD) age and body mass index were 31.6±6.7 years and 26.3±6.1 kg/m, respectively. The incidence of LTs performed for NASH cirrhosis increased from 0.53% in 2002 to 4.46% in 2012. NASH was the most rapidly growing indication for LT among all other etiologies with a 14% increment per year (incidence rate ratio, 1.14; 95% confidence interval, 1.09-1.20, P<0.001). The 5-year post-LT outcomes were comparable between NASH and non-NASH recipients, but graft survival was lower and retransplantation cumulative rates were higher in NASH recipients compared with those with other metabolic liver diseases (63.5% vs. 81.4%, P=0.003 and 12.7% vs. 4.2%, P=0.046, respectively). NASH is the fastest-growing indication for LT among young US adults aged 18 to 40 years and now accounts for almost 5% of all LTs in this age group.

Skipping breakfast is associated with lower diet quality in young US children.

Breakfast consumption has been shown to impact children's growth and development, but the influence of breakfast skipping on total daily intakes is not known. The purpose of this study was to examine the differences in nutritional intakes and food consumption between children who consume breakfast versus those who do not. Dietary recall data were assessed for 2-year-old to 5-year-old children (n = 3443) and 6-year-old to 12-year-old children (n = 5147) from NHANES 2005-2012. Dietary intakes and diet quality scores were compared across breakfast consumption and skipping with means and 95% confidence interval. Children who skipped breakfast on the day of intake had significantly lower energy intakes for the total day (5911 vs 6723 kJ) but had greater energy intakes from non-breakfast meals and snacks. Children who skipped breakfast consumed nearly 40% of the day's intake (2332 kJ of 5911 kJ) from snacks, with 586 kJ from snacks as added sugars. Breakfast skipping was also related to significantly lower intakes of fiber, folate, iron, and calcium intakes. Overall diet quality scores, as well as fruit, whole fruit, whole grains, dairy and empty calorie subscale scores were significantly better in children who ate breakfast. Children who skipped breakfast presented poorer overall diet quality and lower total intakes commonly obtained at breakfast. To address missed opportunities, nutrition professionals should encourage children's consumption of a nutritious breakfast to support overall diet quality.

Sensory and chemical properties of Gouda cheese

Gouda cheese is a washed-curd cheese that is traditionally produced from bovine milk and brined before ripening for 1 to 20 mo. In response to domestic and international demand, US production of Gouda cheese has more than doubled in recent years. An understanding of the chemical and sensory properties of Gouda cheese can help manufacturers create desirable products. The objective of this study was to determine the chemical and sensory properties of Gouda cheeses. Commercial Gouda cheeses (n = 36; 3 mo to 5 yr; domestic and international) were obtained in duplicate lots. Volatile compounds were extracted by solid-phase microextraction and analyzed by gas chromatography-olfactometry and gas chromatography-mass spectrometry. Composition analyses included pH, proximate analysis, salt content, organic acid analysis by HPLC, and color. Flavor and texture properties were determined by descriptive sensory analysis. Focus groups were conducted to document US consumer perception followed by consumer acceptance testing (n = 149) with selected cheeses. Ninety aroma-active compounds in Gouda cheeses were detected by solid-phase microextraction/gas chromatography-olfactometry. Key aroma-active volatile compounds included diacetyl, 2- and 3-methylbutanal, 2-methylpropanal, methional, ethyl butyrate, acetic acid, butyric acid, homofuraneol, δ-decalactone, and 2-isobutyl-3-methoxypyrazine. Aged cheeses had higher organic acid concentrations, higher fat and salt contents, and lower moisture content than younger cheeses. Younger cheeses were characterized by milky, whey, sour aromatic, and diacetyl flavors, whereas aged cheeses were characterized by fruity, caramel, malty/nutty, and brothy flavors. International cheeses were differentiated by the presence of low intensities of cowy/barny and grassy flavors. Younger cheeses were characterized by higher intensities of smoothness and mouth coating, whereas aged cheeses were characterized by higher intensities of fracture and firmness. American consumers used Gouda cheese in numerous applications and stated that packaging appeal, quality, and age were more important than country of origin or nutrition when purchasing Gouda cheeses. Young and medium US cheeses ≤6 mo were most liked by US consumers. Three distinct consumer segments were identified with distinct preferences for cheese flavor and texture. Findings from this study establish key differences in Gouda cheese regarding age and origin and identify US consumer desires for this cheese category.

Identifying risk for type 2 diabetes in different age cohorts: does one size fit all?

ObjectiveTo estimate age-specific risk equations for type 2 diabetes onset in young, middle-aged, and older US adults, and to compare the performance of simple equations based on readily available demographic...

Factors associated with vocal fry among college students

Purpose: Vocal fry is increasingly used in everyday speech. The purpose of this study was to identify associated factors of vocal fry among young US college-age students. Methods: Forty college students participated in a cross-sectional study. Participants produced speech under nine different room acoustic conditions (simulated). The recorded speech was perceptually evaluated by three speech-language pathologists. Multivariate logistic regression analysis was used to identify variables (individual, environmental) associated with the perceptual assessment of vocal fry. Results: A high occurrence of perceptually identified vocal fry was identified among college students. Two factors were significantly associated with lower occurrence of perceptually identified vocal fry: one individual (sporadic consumption of caffeinated beverages) and one environmental factor (speaking in an environment with background noise). Conclusions: Similar to modal phonation, fry-like phonation seems to be influenced by individual and environmental factors. Therefore, clinicians interested in including this technique as part of their intervention programs may take into account the caffeine consumption and the background noise conditions of the room where the therapy will take place in order to facilitate the production of fry-like phonation.